Lodwar Clinic, Turkana, Kenya

Date: July 31, 2016 Prepared by: Romano K. Funo and Deanna Boulard I. Demographic Information 1. City & Province: Lodwar, Turkana, Kenya 2. Organization: Real Medicine Foundation Kenya (www.realmedicinefoundation.org) Medical Mission International (www.mminternational.org.uk) Share International Inc. (www.shareint.net) 3. Project Title: Healthcare Programs – Turkana Drought Region, Northern Kenya 4. Reporting Period: April 1, 2016 - July 31, 2016 5. Project Location (region & city/town/village): Lodwar Town, Turkana, Kenya 6. Target Population: 1. Nabuin Village – 3,100 2. Chokchok Village – 3,561 3. Nadapal Village – 2,723 4. Nayanae Village – 1,060 5. Elelea Village – 2,830 6. Kaitese Village – 3,491 7. Nayuu Village – 2,654 8. Nakabaran Village – 2,926 9. Kanamkemer Village – 6,120 10. Nawoitorong Village – 6,450 11. Lodwar Town - 98,716 12. Lomopus Village – 5,780 13. Nakoriongora Village – 4,670 14. Kangikukus Village – 4,820 15. Napetet – 5,410 16. Nakwamekwi – 6,210 17. Kerio Region – 54,524 (includes: Lokori, Kalokol, Lokichar, Katilu, Kerio, Kalokutanyang, Kimabur, Lochwaa,

Nakepokan, Nakoret, Kaikir, Kapua, Lolupe, Lokichogio, Lomuriae, Lorengelup) Target Population = 250,000 approximately in the area, with services available to any person seeing medical attention II. Project Information 7. Project Goal: To improve the delivery of primary healthcare services to people living in the Turkana Drought Region in Northern Kenya, its capital Lodwar, and the remote villages of Turkana, Kenya. 8. Project Objectives:

• Provide medicines and medical supplies to meet the needs of the target population • Increase mobile/outreach clinics in remote villages • Provide medical services at the health facility in Lodwar Town:

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o Support the medical/physical needs of the target population o Provide home visits as needed o Refer patients needing advanced care to secondary and tertiary care hospitals, and HIV and TB

government clinics o Provide nutrition education and nutritious food o Provide nutrition to babies and young children

9. Summary of RMF/MMI-sponsored activities carried out during the reporting period under each project objective (note

any changes from original plans): Mobile Clinics During the months of April, May, June, and July 2016, the health program successfully conducted 30 mobile outreaches in the remote villages of Turkana, including 2016 STORM medical outreaches. The financial support from RMF/MMI covered the following health program activities in this second quarter of the year 2016: a total of 30 medical outreaches were conducted in the rural villages. Activities performed during the mobile outreaches:

RMF/MMI-sponsored activities Numbers Reached Mobile outreaches Villages visited - 30 Treatment of sick patients in mobile outreaches Patients - 3,904

Cases - 5,090 Total number of STORM mobile outreaches Villages visited - 6 Treatment of sick patients in identified villages during STORM Patients - 2,000

Cases - 3,788 Purchase of medicines/medical supplies for outreaches No. of supply purchases - 3 Emergency referral of patients Patients referred to Eldoret - 2

Patients referred to Lodwar - 35 Home visitation/hospice services No. of visits/patients visited - 22 Provision of food supplements to needy patients in villages Patients given food - 516 Public health education to all patients/community members Public education sessions - 81

Population covered -11,728 Antenatal and family planning care services Clients served -119

Replenishing Supplies Drugs were purchased from a Nairobi pharmaceutical company (MEDS) in the months of April and May, and a large order was filled in June to supply the 2016 STORM operation. These drugs were used during mobile outreaches and STORM outreaches. The clinic staff continues to maintain thorough medicine inventory records. Family Planning In May 2016, 2 of our staff members participated in a program to distribute long acting reversible contraceptives (LARC). The program was carried out by the Kenyan Ministry of Health (MOH) and Kenyatta University as an implementing agency. Additional Training 1 more staff member underwent training on integrated management of childhood illnesses (IMCI). Additionally, in July 2016, 1 more staff member was trained on TB treatment and care with support from the Kenyan Ministry of Health (MOH). STORM Clinics From July 16, 2016 to July 22, 2016, some of our team members were involved in mass treatment of populations during this year’s STORM. Enough drugs were purchased from a Nairobi pharmaceutical company (MEDS) to cover general health problems, including eye conditions, throughout the 2016 STORM period. The following work was completed during 2016 STORM by the Ministry of Health, along with some of our team members:

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Date Village General Treatment

Eye Treatment

Total Patients Total Cases

7/16/2016 MONTI M F M F M F Under 5 years 30 47 2 3 32 50 134

Above 5 years 76 150 15 8 91 158 548 Sub total 106 197 17 11 123 208 682 7/18/2016 KAKWANYANG M F M F M F

Under 5 years 33 37 5 4 38 41 140 Above 5 years 65 104 2 12 67 116 408 Sub total 98 141 7 16 105 157 548 7/19/2016 KAKIRING M F M F M F

Under 5 years 26 41 1 0 27 41 111 Above 5 years 67 104 8 5 75 109 385 Sub total 93 145 9 5 102 150 496 7/20/2016 NABUIN M F M F M F

Under 5 years 39 58 2 7 41 65 138 Above 5 years 108 194 18 14 126 208 589 Sub total 147 252 20 21 167 273 727 7/21/2016 KANGIKUKUS M F M F M F

Under 5 years 35 44 4 8 19 32 130 Above 5 years 79 165 26 23 55 188 501 Sub total 114 219 30 31 144 250 631 7/22/2016 NARONG'OR M F M F M F

Under 5 years 24 30 11 9 35 39 148 Above 5 years 59 148 25 15 84 163 551 Sub total 83 178 36 24 119 202 699 TOTAL 641 1,132 119 108 760 1,240 3,788

Patients treated for eye diseases only: 227 Patients treated for other general diseases: 1,773 Total cases (diseases) for eye patients: 227 Total cases (diseases) for general conditions: 3,561 Grand total of patients treated: 2,000 Grand total of cases seen: 378 10. Results and/or accomplishments achieved during this reporting period: General outpatient treatment:

- Mobile outreaches - Lodwar Clinic - 2016 STORM, July

As seen in the table below, the project reached and treated a large number of patients. Mobile outreaches Lodwar Clinic 2016 STORM, July Patients treated in mobile outreaches Patients treated in Lodwar Clinic Patients treated in 2016 STORM

M F Total Cases M F Total Cases M F Total Cases April 399 564 963 1,040 465 544 1,009 1,109 May 303 412 715 822 655 782 1,437 1,672 June 533 605 1,138 1,957 1,062 1,271 2,333 2,786 July 524 564 1,088 1,271 696 851 1,547 1,860 760 1,240 2,000 3,788 Total 1,759 2,145 3,904 5,090 2,878 3,448 6,326 7,427 760 1,240 2,000 3,788 Total patients treated: 11,728 Total cases reached: 16,305 Emergency referrals: Patients were referred for further treatment at secondary and tertiary medical facilities through both our mobile outreaches and Lodwar Clinic. Patients needing referrals were sent to Lodwar County & Referral Hospital or to a facility outside the county, such as the Moi Teaching & Referral Hospital  (MTRH) in Eldoret. During this quarter, we referred a

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total of 37 patients to hospitals: - 35 patients were referred to Lodwar County & Referral Hospital. - 2 patients were referred to  the Moi Teaching & Referral Hospital (MTRH) in Eldoret.

Laboratory diagnostic services: Laboratory tests were performed for diagnostic purposes at Lodwar Clinic, improving the quality of services offered to patients.

- 2,516 laboratory tests were performed in Lodwar Clinic. - 1,763 of the patients tested positive for the disease being investigated.

HIV testing and counseling:

- 317 patients were offered health testing and counseling. - 39 patients tested HIV-positive. They were referred to Lodwar County & Referral Hospital for HAART.

Immunization and deworming services: Immunization of children under five years old is usually completed both in the mobile outreaches and in the Lodwar Clinic.

- 407 children were immunized during this reporting period.  

Deworming of children under five years old is also completed in both mobile outreaches and Lodwar Clinic. Patients are given either Albendazole or Mebendazole.

- 713 children were dewormed during this reporting period, including: • 405 male children and • 308 female children.

Antenatal and family planning services:

- 119 women of reproductive age received antenatal and family planning services.

Home visits: Most home visits are performed during mobile outreaches, when our team goes to patients who are unable to come to us for treatment. Typically, these patients are seriously ill, disabled, or quite elderly. On rare occasions, relatives come to Lodwar Clinic requesting a home visit for their loved one who is unable to reach the clinic for medical care.

- 22 home visits/hospice services were provided to needy community members during this reporting period. Nutrition services and health education: Nutritional supplements are given to malnourished children and pregnant and lactating mothers.

- 541 children and mothers benefitted from our nutrition program. Alongside nutritional supplements, foods like snacks, milk, drinks, and fruit are usually offered to needy patients during our mobile outreach program.

- 119 needy patients (approximately) received snacks and other additional nutritional support. During mobile outreaches and at the beginning of the day at Lodwar Clinic, public health education is usually provided before treatment.

- 81 public health education sessions were conducted, covering all patients treated. Rubella and measles campaign: This nationwide intervention was carried out by the Kenyan Ministry of Health (MOH) in May for a period of 9 days. 4 of our staff members took part in this national campaign.

- 12,784 targeted beneficiaries were immunized for rubella and measles. - Our target had been 2,000 children. This was acknowledged by the MOH as a well done job.

Note: Respiratory tract infections, malaria, and diarrheal diseases remain a major public health concern in this quarter according to our statistics. 11. Impact this project has on the community (who is benefiting and how):

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Having adequate medical personnel and medicine stores has enabled us to treat more patients and combat a wider range of diseases on a regular basis, especially in the remote villages of Turkana. The project’s target population is estimated at 250,000 and rising. The improved quality and regularity of medication purchase from MEDS in Nairobi through RMF/MMI funding has allowed the clinics to be conducted and improved the quality of the service. Previous to RMF/MMI involvement, medication was scarce and depended on the availability of specific donations each month. Rural population: Approximately 187,500 of the people in our target population are men, women, and children who live in the remote, inaccessible areas of Turkana county and have no access to medical care. Additionally, the nomadic nature of the Turkana tribe causes the people of these villages to migrate about every 4 months and a new group of villagers arrives about every 4 months; therefore, we are providing service to more than the estimated population of persons living in each village at one time. Most of this rural population depends on herbs and witch doctors for medical services. The project has safeguarded these community members from herbal poisoning and the dubious, expensive medical attention of witch doctors. This quarter, a total of 11,728 patients were treated at our 30 mobile outreach clinics and at Lodwar Clinic. Treatment of common diseases: We provide medicines for the target population, lowering mortality rates through free and regular treatment of diseases like malaria, respiratory diseases, diarrheal diseases, skin conditions, and eye conditions, which are linked to high mortality rates throughout Africa, including Turkana, Kenya. In this quarter, the project has treated a total of 16,305 cases. Immunization program: Because of our presence, children under five and pregnant mothers can now access vaccination services in the remote villages of Turkana, hence acquiring herd immunity against prevalent diseases. By improved immunization coverage, RFM/MMI/SIHP’s project helps achieve the government goal of providing preventive health care to at-risk populations, which include children under five and pregnant women. A total of 407 children benefited from our immunization program during this reporting period. Health promotion: On every working day, either through mobile outreach clinics or Lodwar Clinic, Community Health Extension Workers (CHEWs) have a responsibility to disseminate key messages concerning disease prevention through public health education sessions. This enlightens and empowers the community to take initiative to improve their health, hence preventing a wide range of diseases. In this quarter, 81 public health education sessions were carried out covering all patients treated 11,728. Nutrition supplementation: Through partnership with other health agencies, the project provided nutrition supplements to 531 beneficiaries, which were comprised of children and pregnant and lactating mothers. Some patients with special needs have also been able to access other food support during mobile outreaches and at the clinic. Emergency referral: The project has been able to provide emergency referral services to needy patients using the program’s ambulance. This gives patients an exceptional opportunity to access advanced medical care such as HAART services, TB treatment, cancer treatment, eye surgery, delivery services, physiotherapy, and other laboratory services which Lodwar Clinic cannot offer with ease. In this quarter, the project was able to refer 35 patients to Lodwar County & Referral Hospital, and 2 patients to Moi Teaching & Referral Hospital in Eldoret for further medical care. Laboratory services: Patients coming to RMF/MMI/SIHP’s clinic for medical attention receive laboratory diagnostic services. This improves accuracy and quality of service to the program’s target beneficiaries. Part of the diagnostic testing done on a daily basis includes HIV testing and counseling. For HIV screening, 317 clients were tested and 39 were HIV-positive; they were referred to Lodwar County & Referral Hospital for HAART. In this quarter, 2,516 patients were tested for various diseases and 1,763 indicated positive results. Lodwar Clinic reputation and partnerships: The project is widely appreciated in the Turkana region, and many people prefer Lodwar Clinic or our mobile clinics to the region’s few other health facilities. Thanks to the support of RMF/MMI, patients have received timely service provision, and our services are effective and accurate due the availability of diagnostic laboratory tests and sufficient,

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reliable medications purchased from a Nairobi pharmaceutical company (MEDS). In addition to the steadfast support of RMF/MMI, the project is now benefiting from other partners, including the Elizabeth Glaser Pediatrics Aid Foundation (EGPAF), which recruited and deployed 2 staff members to the clinic in May 2016. These staff members were provided to carry out mobile outreaches and further EGPAF’s Beyond Zero projects. We have requested that the staff members work in Lodwar Clinic during the times when mobile outreaches are not being conducted. The Turkana county government has also deployed 4 Community Health Extension Workers (CHEWs) and 1 laboratory technician to the Lodwar Clinic. Thanks to the support of RMF/MMI, the availability of sufficient medication and personnel has enabled us to treat more patients and combat a wider range of diseases on a regular basis, both in the Lodwar Clinic and in the remote villages of Turkana. 12. Number served/number of direct project beneficiaries (for example, average number treated per day or month and if possible, per health condition): In this quarter, a total of 11,728 patients were treated. There were 5,133 male patients treated and 6,595 female patients treated. The total cases treated for the quarter were 16,305. Please see Appendix A 13. Number of indirect project beneficiaries (geographic coverage): Our services are also available to all residents of Central, South, and Western Turkana; approximately 900,000 persons. 14. If applicable, please list the medical services provided: - Outpatient diagnosis and treatment - Medication available with pharmacy counseling - Public health education with each clinic session - Minor surgery - Wound care - Laboratory diagnostic services - HIV testing and counseling - Referral to secondary and tertiary care centers for advanced care - Nutrition supplementation for malnourished children, the elderly, and terminally ill during mobile outreach clinics and

home visitations - Care of patients with advanced and/or special needs: arranging transport and staff accompaniment if needed to

referral centers for special consultations, procedures, etc. 15. Please list the five most common health problems observed within your region. - Respiratory tract infections - Malaria - Gastroenteritis - Skin diseases - Eye infections 16. Notable project challenges and obstacles: - There is increased need for health services in rural villages. - Special referral cases needing external referrals require extra funds to meet their out-of-county medical bills. - During mobile outreaches, the privacy of patients is compromised when undergoing antenatal and abdominal

examinations. - Lodwar Clinic is currently short of 2 medical staff members. - We struggle with inadequate space during these routine activities:

• Immunization and nutrition supplements • Patient observation while on intravenous infusions

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• Antenatal and family planning care • Mothers coming for delivery • Health testing and counseling for HIV • Office for supervisory staff to facilitate administrative tasks

- The safe water supply and storage capacity at Lodwar Clinic are very limited. - Lodwar Clinic lacks a compound fence; a fence would increase the security and tidiness of the clinic.

17. If applicable, plans for the next reporting period: - Conduct at least 21 mobile clinics - Conduct at least 12 hospice visits, which are home visits to the very ill - Support continuity of public health education in mobile clinics and Lodwar Clinic - Purchase medicine from the pharmaceutical company (MEDS) in Nairobi, Kenya. - Offer emergency transport to needy patients from rural villages to our clinic or elsewhere for necessary medical

care. - Continue looking for additional medical support from willing partners like the County Government of Turkana

supplying the program with medicines on a quarterly basis through the Ministry of Health, and other NGOs. - Search for more ways to meet the needs of the special cases requiring funds not in the budget, e.g. support for

people living with TB and HIV/AIDs 18. If applicable, summary of RMF/MMI-sponsored medical supply distribution and use: Please see Appendix B 20. Success story(s) highlighting project impact: By Romano Funo

JACKSON IPASU is a 40-year-old man, married with 4 children. On July 19, 2016, our team identified Jackson as a patient who had been living with cancer for over 3 years due to a lack of referral funds. His caretakers reported that they had spent over KSh. 30,000 on previous treatment attempts without success. Now they had no remaining money for treatment. With the support of Dr. Sammy, our team mobilized KSh. 130,000 to refer Jackson to Eldoret for medical assessment during the 2016 STORM. Jackson was referred to Eldoret on July 24, 2016 and arrived in Eldoret on July 25, 2016.

After completing all of the necessary pathological, radiological, and laboratory investigations, the doctor diagnosed Jackson with cancer, left lytic bone destruction, anemia, and sepsis. He needed emergency admission for intravenous treatment, further investigation, and palliative care to regain lost consciousness and health status.

Jackson was admitted to the Alexandria Cancer Centre in Eldoret despite the down payment of KSh. 35,000 requested by the doctor in charge. After a lengthy discussion between our staff member, Romano, and Dr. Melly, the cancer center’s owner  and lead physician, they agreed that the patient would begin treatment while information was taken to the referral point for mobilization of admission charges approximated at KSh. 480,000.

On July 29, 2016, Romano Funo placed a phone call to follow up with both Jackson and Dr. Melly in the Alexandria Cancer Centre. Romano was able to confirm that Jackson was continuing with treatment. He also learned that the doctor had found erosion in some of Jackson’s vertebral boney tissues. The consultant doctor was called to do another MRI for the vertebral column. The consultant doctors are more optimistic of recovery and improvements. Plans are underway to visit Jackson once

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again in Eldoret for follow-up reasons and to provide psychosocial support. Plans are also underway to mobilize funds for admission costs from any willing well-wishers. This life-changing support is available to the region’s community members through our mobile clinics and Lodwar Clinic.

Jackson undergoing investigations in Eldoret

Jackson admitted to the Alexandria Cancer Centre in Eldoret

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Health education at one of our mobile outreach clinics

Consultation in progress at one of our mobile outreach clinics

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RMF CEO Dr. Martina Fuchs with RMF and Share team

III. Financial Information 21. Detailed summary of expenditures within each budget category as presented in your funded proposal (file

attachment is fine). Please note any changes from plans. E-mailed separately from accountant.

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APPENDIX A Total patients treated – 11,728 Total cases seen – 16,305

a) Morbidity by Disease Type

b) Morbidity by Village

Disease Male Female Total Malaria 1,737 1,887 3,624 Respiratory tract infections 1,708 2,063 3,771 Brucellosis 77 98 175 Skin 484 553 1,037 Urinary tract infections 94 127 221 Gastroenteritis 398 416 814 Eye infections 179 211 390 Dental infection 18 21 39 Dysentery 62 81 143 Typhoid 139 131 270 Ear 45 85 130 HIV 13 26 39 Allergy 181 195 376 Myalgia 182 173 355 Sexually transmitted diseases 34 44 78 Malnutrition 129 382 511 Accidents 56 67 123 Asthmatic attacks 7 11 18 Worm infestation 749 532 1,281 Anemia 10 57 67 Burns 39 22 61 Bites 59 39 98 Rheumatoid Arthritis 13 18 31 TOTAL 7,119 9,186 16,305

Village Male Female Total Nawoitorong 1,225 1,580 2,805 Kanamkemer 1,141 1,382 2,523 Kerio 93 181 274 Nariamao 154 184 338 Kaikir 107 176 283 Lokichar 56 89 145 Nakudet 167 196 363 Nayuu 143 230 373 Nakabaran 84 112 196 Chokchok 248 271 519 Kimabur 114 163 277 Nakoriongora 162 239 401 Lomopus 250 343 593 Nabuin 97 53 150 Town center Lodwar 165 187 352 Napetet 190 251 441

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c) Morbidity by Age

d) Laboratory Report

e) Immunization Report

Nakabaran 124 212 336 Lodos 157 245 402 Elelea 153 174 327 Nakwamekwi 185 177 362 Kalokutanyang 118 150 268 TOTAL 5,133 6,595 11,728

Age Male Female Total 0-5 1,546 2,183 3,729 6-15 1,070 1,321 2,391 16-24 1,232 1,617 2,849 25-49 754 1,043 1,797 50+ 521 441 962 TOTAL 5,133 6,595 11,728

Category

No. of Tests Done

No. of Positive Tests Done

Male Female Male Female Malaria -blood smear 727 785 586 697 Typhoid - Widal test 146 112 64 109 Brucellosis - Brucella test 86 101 42 87 Urine- urinalysis 39 45 20 38 Pregnancy- urine N/A 63 N/A 56 Blood grouping 10 19 N/A N/A Syphilis-blood for VDRL 18 17 2 2 Stool-for Amoebiasis 9 13 3 8 Gonorrhea 0 9 1 9 Blood for HIV (HTC) 114 203 17 22 TOTAL 1,149 1,367 735 1,028

Name of vaccine Male Female Measles 13 22 BCG 17 11 Polio 10 57 Rotavirus 13 16 Pneumococcal 39 53 Pentavalent vaccine 39 53 Tetanus toxoid for expectant mothers

N/A 64

TOTAL 131 276